Background. The preponderance of evidence suggests that smokers do not enga
ge in health-promoting lifestyles compared to nonsmokers. Few studies, howe
ver, have considered possible differences in health behaviors among smokers
at different stages of intention to change. In this paper we examined the
relationship of smoking stage of change to health behaviors in an HMO popul
ation.
Methods. Data were obtained from a baseline health status and preventive se
rvice evaluation survey mailed to 8000 HMO members over the age of 40. The
sample was stratified based on the presence of one or more chronic diseases
. Regression analyses were performed adjusting for covariates and weighting
based on the stratification.
Results. Smokers appear to vary by stage of change in their practice of hea
lth-promoting behaviors. After controlling for age, gender, professional ad
vice, chronic disease, and education, smokers classified in early stages of
change demonstrated significantly fewer positive health practices compared
to never smokers. A consistent pattern emerged across health behaviors.
Conclusions. Smokers in the earliest stages of change appear to have the mo
st room for improvement compared to ex-smokers and never smokers. Behavior
change other than smoking could be an opportunity to engage early stage smo
kers. (C) 2000 American Health Foundation and Academic Press.